Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
Int J Cardiol. 2012 Jul 12;158(2):205-10. doi: 10.1016/j.ijcard.2011.01.022. Epub 2011 Feb 24.
Few data describe the case burden of heart disease and cardiovascular risk factors relative to other conditions in urban Africans seeking primary health care.
A clinical registry captured data on 1311 consecutive primary care patients (99% African) from two primary care clinics in Soweto, South Africa. Those with suspected sub-clinical heart disease had more advanced cardiologic assessment.
Overall, 862 women (66%, 41 ± 16 years) and 449 men (38 ± 14 years) were studied. Whilst more men were smokers (47% vs. 14%; OR 5.23, 95% CI 4.01-6.82), more women were obese (42% vs. 14%; OR 4.54, 95% CI 3.33-5.88); blood glucose levels doubling with age in obese women. Although 33% were hypertensive, only 4.9% had type 2 diabetes (n=45), heart disease (n=10) and/or cerebrovascular disease (n=12). Overall, 16% (n=205) had an abnormal 12-lead ECG with more men than women showing a major abnormality (24% vs. 11%; OR 2.63, 95% CI 1.89-3.46). Of 99 cases (7.6%) subject to advanced cardiologic assessment, 29 (2.2%) had newly diagnosed heart disease: including hypertensive heart failure (13 women vs. 2 men, OR 4.51 95% CI 1.00-21.2), coronary artery disease (n=3), valve disease (n=3), dilated cardiomyopathy (n=3) and 2 cases of acute myocarditis.
These data demonstrate a relatively low burden of heart disease in urban African patients seeking primary health care. Alternatively, high antecedent risk, particularly among obese women, highlights a key role for enhanced primary prevention.
在寻求初级保健的城市非洲人中，很少有数据描述心脏病和心血管危险因素的病例负担相对于其他疾病的情况。
一个临床登记处从南非索韦托的两个初级保健诊所中收集了 1311 名连续的初级保健患者的数据（99%为非洲人）。那些疑似亚临床心脏病的患者接受了更先进的心脏评估。
总的来说，有 862 名女性（66%，41 ± 16 岁）和 449 名男性（38 ± 14 岁）接受了研究。虽然更多的男性是吸烟者（47%比 14%；OR 5.23，95%CI 4.01-6.82），但更多的女性是肥胖者（42%比 14%；OR 4.54，95%CI 3.33-5.88）；肥胖女性的血糖水平随年龄增长而翻倍。尽管 33%的人患有高血压，但只有 4.9%（n=45）患有 2 型糖尿病、心脏病（n=10）和/或脑血管疾病（n=12）。总的来说，16%（n=205）的人有异常的 12 导联心电图，其中男性比女性表现出更严重的异常（24%比 11%；OR 2.63，95%CI 1.89-3.46）。在 99 例（7.6%）接受高级心脏评估的病例中，有 29 例（2.2%）新诊断为心脏病：包括高血压性心力衰竭（13 名女性与 2 名男性，OR 4.51 95%CI 1.00-21.2）、冠状动脉疾病（n=3）、瓣膜疾病（n=3）、扩张型心肌病（n=3）和 2 例急性心肌炎。
这些数据表明，在寻求初级保健的城市非洲患者中，心脏病的负担相对较低。或者，高前置风险，特别是在肥胖女性中，突出了强化初级预防的关键作用。
